Hello and welcome to FAB Gab. This is the podcast for the International Journal of feminist approaches to bioethics brought to you by FAB Network. My name is Kathryn MacKay. And today I'm joined by Ylva Gustafsson from the Abo-Akademi in Finland, to discuss her paper, 'a critical analysis of neurological theories on empathy in healthcare,' which appears in volume 14 number two of IJFAB. Hello, Ylva.
Hello, Kathryn. Thanks for inviting me to this podcast.
It's a pleasure to have you. And I'm very excited to talk about your paper today. So I wonder to get the conversation started. Could you give a brief overview of the paper for our listeners?
Yes, I'll try to do that. I could, perhaps briefly summarize my paper by saying that so the main theme of my article is that I discuss critically neural neurological theories on empathy in healthcare. And these kinds of neurological conceptions of of empathy are today quite popular in in many scientific areas. And in this paper, I argue that neurological theories on empathy have also come to have an impact in in healthcare. So, these kinds of theories are used, for instance, in training medical students to become sensitive to patients, facial expressions, for instance, but also another field where these kinds of neurological theories on empathy are used today, in order to explain why care work is emotionally exhausting or why healthcare staff become burnout. So, in the article, I argue then that these kind of neurological theories on empathy build on on several kinds of conceptual confusions, those who are connected with methodological confusions in the research. And, and, and I think one can see this in that researchers create, they tend to create very restricted neurological experiments when they want to study empathy in healthcare, and this is one problem, I try to address them. So, instead of this, I tried to argue then that this kind of neurological approach to empathy will not help us understand what Empathy means, in healthcare settings. And, and then I tried to look instead on various examples, and case studies of what it could mean to care for another person in a healthcare setting, but also in family settings. And I discuss then examples of how how considerate care can can take an embodied form in various ways. And I also tried to show how how these ways of caring centrally have an ideological form and I think that this dialogical aspect of of caring is not acknowledged enough, among other things in this neurological approach. So, so, I tried to argue in the paper that that empathy should be understood as a dialogical and also an as an ethical response to to the person and, and I could also say that the paper is consists of two parts and in the second part, I, I focus on on the idea that emotional exhaustion or burnout could be explained then as a neural neurological reaction of too much empathy. And so also here a question, this theory, and the way it's built on experimental research, and And I argue that if if we want to understand how caring for another person can be exhausting or difficult, it is important to look at the daily care settings of working in health care, but also of of helping a family member for instance, and and how such situations can be difficult in various ways and exhausting. So, one has to see the whole context and life situation in order to understand what what it can mean to to care for another person and try to be considerate and compassionate. But also if you want to understand what's difficult in and in health care, one has to understand the context rather than look at the brain, if I may say so.
You work in philosophy of mind, right?
Yes, yes, I do. Yes.
Have you been working on issues around empathy in neurological approaches empathy for a little while?
Yes, I have. I have been working on on could take perhaps that I have, because I have I have for a long time. Been focussed, I guess, on philosophical perspectives that are connected to, to philosophy of mind. And, and, and my main focus has in a way been questions concerning interpersonal understanding. And I have tended to take a critical approach to a certain kind of philosophy of mind that I think influences psychology quite much, or at least some kind of psychology, color research and also influences these neurological theories on empathy. So, so one could say, perhaps, basically, that, when Yes, when other fields I have long for a long time, we're looking at his field of emotions, because emotions, how emotions are discussed in philosophy often reflects a kind of problematic idea about interpersonal understanding, where the problem, basic problematic idea, I think, is that the idea that interpersonal understanding would consist in one mind understanding another mind. And this idea, I think, one can also see in, in the neurological, conceptual of everybody, there is the idea that we have one brain that has to understand another brain in a way, and that this then can explain empathy also in healthcare. So, and so this has, I think, for a long time, I've been interested in this kind of mentalistic approach towards interpersonal understanding, and I try to have tried in various ways instead to argue or or suggest that interpersonal understanding, should be seen as, as, always, in some sense dialogical, that the biological aspect of interpersonal understanding where we, we, we meet another person, and we talk with the person, or we, we do something together, or we, we, we, we joke, or we quarrel, or we, we argue this is the primary form of what it means to another, understand another person. And when, when we, when we on a distance, try to understand what another person is thinking, that is a quite special situation. And, and usually, usually, when we also wonder what another, another person thinks we, we asked the button. So, what do you think about that, though this, we don't use this kind of mental methods to decipher what's going on in the person, but rather, we ask, and then the person says something, and then we've said, say something back. So I'm trying to say that this is also very central in healthcare settings that help in health care. Working with patients, and and also attending to patients, it's, it is essentially a dialogical situation where you, you talk with the patient, and that's really important for what empathy also means. And also when we try to understand, you know, when we respond in an in a bodily sense, so to say, that also takes a biological form,
I wanted to ask you about why you included dementia in the paper, because I thought that that was quite interesting. And so for the listeners, one of the or a few of the examples, towards the end of the paper involve healthcare settings, where a person or actually family settings as well, where a person might be caring for someone with dementia. And I wondered if you could just say something for the listeners about why dementia might be an interesting example, to trouble these accounts of empathy.
I think dementia is an interesting field philosophically, because there's a lot of if one looks at stories about the dementia care work, they can I guess, be lots of difficult situations where one might one might have difficult to understand the person who has dementia. But also, I think it's important to see why interest here was also in dementia because one on one aspect with dementia is that and one reason I discussed it in this paper is that, that I tried to show that I started to question the idea that emotional exhaustion or burnout would be a neurological phenomenon where one in a way sees the suffering of another person and then one feels to suffering oneself somehow in the brain and then one gets very tired and emotionally exhausted. So, my question that idea of, of making emotional exhaustion into a kind of momentary state in the brain, emotional state of something and then I have looked at some cases of descriptions of, of how relatives for instance, can find it difficult to Care for family members with dementia and they, in the stories I tried to bring out in the stories that for instance, taking care of a family member in home, if the family member has dementia and for instance wakes up every night, and goes walking somewhere, that in the long run, if that goes on for years, it's extremely exhausting. Just that experience. And and also, for instance, situations where things can become dangerous. There is this story by by Arthur Frank, where he describes her a woman who tells that her mother moves around in the kitchen in ways that can be dangerous, so she can touch the hot stove suddenly, and, and these kinds of when you constantly have to be on your lookout, looking out for your parents, for instance, because you're afraid that something dangerous might happen, because the parent doesn't really remember what's what's safe or not. That becomes exhausting. And so the point there is that emotional exposure or burnout, or what one should call it, is not just a momentary feeling in or not the brain actually in that sense, even if it might be the case that you can see Granger Granger reactions in this, it still, it's important to see the whole life situation and how it can go on for years. This, what it means to care for a family member. And also, for instance, I think it's important also that family members are often left quite alone with their caring responsibilities. So healthcare is not helping enough, or giving them enough relief in this care work. So and that is, in the end, can become very exhausting in that, because of this, they don't get a chance to get a break, so to say. And it's a huge responsibility also. So there's also an ethical side here that that can help huge, huge responsibility to care for, to be alone in your care for a person with dementia. But also, there can be other other difficult sides so that sometimes people with dementia can, can become unpredictable in the sense that they can become aggressive. This doesn't have to be the case always. But sometimes that can be the case. And that can also become difficult. And if you don't know when a person suddenly will become very aggressive or not, it becomes really difficult to, to have a kind of trustful relationship where you can enjoy each other's company. But but then I also tried to bring it out in here in the papers, that there are, it doesn't always have to be the case that caring for people with dementia is only so to say something dark or what was social. But rather,
it's also important to see that, that the way for instance, nurses are also family members can acknowledge people who have dementia that it can also often have a kind of side where you you create the kind of meaningful situation for for the person. So I have an example here in the article where is not my example, I have taken them from other researchers. So so but there is a story where where a woman tells of her husband that the husband, when they are out walking or driving a car, they he says that he sees black words on the roads. And when the woman first says that I can't see any birds, then he gets sad. But then, when another time when the man against his blackbirds, she says that, oh, they are capercaillies, and then he gets really happy, because then they can see these couple of piglets together. And and this is one example of how even even if the man has these hallucinations, that the the wife doesn't, doesn't treat his hallucinations as if he was. He doesn't she doesn't say it to him that this is just an illusion. And rather, she goes with him in this hallucination at the end to give some meaningful context. And that's one way of showing compassion in a way in this situation, and one can see similar kinds of situations also in care work with people who have dementia that that nurses try to adapt or adjust their ways of responding. Where they don't just say that, no, you're irrational here or you're not. You don't understand the situation you're in in now. As soon as they create a meaningful situation from what the person says in this specific situation, so I'd say so, I think I think this case is when one looks at studies of of care work. With people who have dementia, one can see how how care and compassion takes a relational form, and also is very much focused on a specific context. And where the specific person and his or her life situation is considered, then in there, so to say,
to maybe phrase it to you, and to see if you agree with this, but it kind of what it sounds like to me is that the nurse or the family member, is able to apprehend the pain or the discomfort or the anxiety or the sadness of the person that they're caring for in this example, seeing black birds or understanding that this, that your husband is sad or distressed when you don't see the birds, and that there's empathy happening through this context of understanding all of what that person is going through, but that it couldn't, it doesn't have to simply rest on something as neuro functional as mirror neurons, because maybe that doesn't even make sense in the case of Alzheimer's type dementia.
Yeah, no. Yes, there'll be the mirror neurons, as you mentioned, that that's one one theory, the mirror neuron theory that has had quite a big influence in, in also in these theories on neurological theories on empathy, say, and briefly, I could perhaps say that, if somebody is not acquainted with the mirror neuron theory, the mirror neuron theory builds on research from the 1980s, where researchers discovered that they made this experiment where they had this macaque monkeys, I think it was that. And so when macaque monkey was I don't remember exactly what something like one macaque macaque monkey was given a banana and then the date the banana. And then another macaque monkey was looking at this monkey eating the banana and, and then you could see similar brain reactions in both monkeys heads. And from this research, there came the theory that, that understanding another person consists in this kind of mirror neuron system, that we have the same mirror neurons that react in our brain when we understand what goes on in another person's brain. Well, there are some this this experiment has been criticized by other researchers, partly because macaque monkeys are not very much alike, human beings. One thing that they differ one way they differ is in that macaque monkeys are really lousy at imitating, but this theory about mirror neurons has become quite influential. And especially when it comes to theories on empathy, and because this, the idea is that we have the same emotional reactions in our brains, that kind of imitative reaction, but as you say, when it comes to dementia, that actually is one example where it would not work because because the one who responds to, for instance, his wife, who responds to her husband, in this case, she's she's not having the same blackbirds in her head. And that's exactly the point that she's not in a way, seeing this backwards at all. And, and, but she understands his life situation that he that he has, he wants to share something he wants to, he wants to talk about this beautiful, or this kind of this word. And that's, that is something I think also that is a mistake, when one thinks of mirror neurons that it's a mistake, the things that think that sharing experiences means that we have to have the same inner feelings, but other in human life, when we share experiences. That is something we do really, also in a life context, we, when we share experiences, we we talk together about something I tell you something about oh, today I did this and that and that happened and then you might answer me Oh, really. And so, an Ori, this this example, in the article, I have a quote from Julieta, who has this example where two people go out for a walk together in the woods and they they look at the birds and they look at the trees and while they walk together. They they also talk about various stuff. And these that they work together is one way of sharing the experiences and also the talking. So sharing experiences is not a matter of two people have having the same inner states rather of doing something together. But also sharing experiences but also something that very much has meaning because we have a sort of life history together. So in the case with the man and wife who see, birds together should say they have a whole life behind them. And that's also something that gives meaning to, to the man's words. Oh, look, there's black birds, he's talking to his wife there. And, and her response is also something that is meaningful because they have a history. And, and also, this is also important when it comes to, to dementia in a way in then in many ways, because Because sharing experience can be for instance, I have another case story there, where a woman
says, after she has had lunch, she says that, oh, now it would be nice to go home. And then the nurse Well, she can't go home because she's in a care home and but she in a way doesn't understand that she can't go home anymore because she has dementia. And then this nurse, this is a kind of tricky situation, because this is a situation where the demented woman might very easily become sad, when she would realize that, that she has been mistaken that she can't ever go home anymore. So it's a kind of situation that might cause a lot of grief. But the nurse manages then to carefully change the situation by stalking, saying that, yes, home is important for all of us. And, and then then then somehow they come into talking about her for her home as a something that she remembers her parents and, and they talk about her parents and her childhood. So so they're in a way, the nurse manages to steer the conversation into a shared reflection of, of these memories of her childhood. And this, this way of remembering her childhood clearly has meaning for this demented woman that they remember together. And she can tell about her mother and father and how she missed them when they had to go away and as a kid, and so. So they're also the nurse manages to share a life in a way by in a way creating a meaningful context out of a situation that could have become a kind of situation of despair.
Were there any Did you have any particular challenges in doing this research or writing this paper?
Yes, I could say, well, in one sense, I guess it's always difficult to, to write, I think but and I've never been a very fast researcher and quite slow. But writing this article was difficult. And I sent it in several times to to international journal of feminist approaches to bioethics. And it was sent back with a lot of comments by the external reviewers. And it was sent sent back two times. And I could say that my own impression of the difficulties was first first I had written a paper that was full of too much stuff in a way. And it was too messy. And then, so and then perhaps the second time, I tried to add, then I got comments on that. That was that was one comment. If I understood it was there was too much. And too it was unclear what I was writing or talking about. And I guess that is one problem that is often can often be the case. Also, for others, I guess but the second time I tried to change in the paper, I think I in some sense, I maybe the problem then was that I had somehow perhaps I had lost my own thoughts in the in the second version. And then I in a way, if I understood the comments correctly, that was one problem that in a way, I had lost a lot of my own reflections. And then I tried to work with only the third time and then it was accepted finally, but it was hard work to get the paper ready. But But also, I think it was really helpful to get this kind of comments by the reviewers to get this kind of help to try to consider and to see because it's difficult to see oneself what the problem might be with the paper so to get comments from others is really helpful and, and and also to get for suggestions of what to read. And and Or how to focus the paper in various ways. So it was a lot of work. But yeah, I'm also grateful for all the help I got from from the journal for working with this paper. So yeah, it was a big struggle to Getting ready. But But
yeah, that putting too much stuff in that sounds very familiar to me. That's a problem with my papers.
Yeah, I guess I'm not the only one in the world.
Yeah. So I guess just as a final question for you, but if there is the kind of single point or a couple of points that you really hope that readers take away from your paper, what would they be?
Maybe a takeaway point from from the paper would be that, that if we want to try to understand empathy in healthcare, we should try to look at concrete life situations and, and, and, and situations in care work. And also, their stories and narratives of in from health care. And, in one sense, I think there's a lot of researchers who do this already. So it's not this is not something new, I'm saying but but. But I think also that there is a tendency that is problematic in that in philosophy, I think there's all hope, often a tendency, that that examples are not given enough attention. And, and instead, that philosophy can become too abstract. And if, if it has to do with healthcare philosophy, then I think it's really important to look at examples are real, real life situations and stories. And also, I think it's a problem when restricted experimental research is getting more rule. And, and so say this kind of attention towards pre life situations, in a way seems to get less true in certain kinds of research when it comes to health care. So yeah, that's, I guess, the takeaway point of the article, I guess. Excellent. Well, thank
you so much for speaking with me, Ylva. It was really, really interesting.
Thanks. Thanks for for talking with me. It was nice to talk with you.
Thank you, you too. And thank you so much to everyone for listening to this episode of FAB gab. You can find Elvis paper linked in this episode's notes along with the transcript. Fab gab is hosted and produced by me, Kathryn McKay. You can find our other episodes on Spotify, radio, public anchor or wherever you get your podcasts or quality. Thanks again for listening. Bye
